Adjunctive IgM-enriched immunoglobulin therapy with a personalised dose based on serum IgM-titres versus standard dose in the treatment of septic shock: a randomised controlled trial (IgM-fat trial)

IntroductionIn patients with septic shock, low levels of circulating immunoglobulins are common and their kinetics appear to be related to clinical outcome. The pivotal role of immunoglobulins in the host immune response to infection suggests that additional therapy with polyclonal intravenous immunoglobulins may be a promising option in patients with septic shock. Immunoglobulin preparations enriched with the IgM component have largely been used in sepsis, mostly at standard dosages (250 mg/kg per day), regardless of clinical severity and without any dose adjustment based on immunoglobulin serum titres or other biomarkers. We hypothesised that a personalised dose of IgM enriched preparation based on patient IgM titres and aimed to achieve a specific threshold of IgM titre is more effective in decreasing mortality than a standard dose.Methods and analysisThe study is designed as a multicentre, interventional, randomised, single-blinded, prospective, investigator sponsored, two-armed study. Patients with septic shock and IgM titres <60 mg/dL will be randomly assigned to an IgM titre-based treatment or a standard treatment group in a ratio of 1:1. The study will involve 12 Italian intensive care units and 356 patients will be enrolled. Patients assigned to the IgM titre-based treatment will receive a personalised daily dose based on an IgM serum titre aimed at achieving serum titres above 100 mg/dL up to discontinuation of vasoactive drugs or day 7 after enrolment. Patients assigned to the IgM standard treatment group will receive IgM enriched preparation daily for three consecutive days at the standard dose of 250 mg/kg. The primary endpoint will be all-cause mortality at 28 days.Ethics and disseminationThe study protocol was approved by the ethics committees of the coordinating centre (Comitato Etico dell’Area Vasta Emilia Nord) and collaborating centres. The results of the trial will be published within 12 months from the end of the study and the steering committee has the right to present them at public symposia and conferences.Trial registration detailsThe trial protocol and information documents have received a favourable opinion from the Area Vasta Emilia Nord Ethical Committee on 12 September 2019. The trial protocol has been registered on EudraCT (2018-001613-33) on 18 April 2018 and on ClinicalTrials.gov (NCT04182737) on 2 December 2019.

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Drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation: 10-year follow-up of a randomised controlled trial

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318231 ◽

2020 ◽

Vol 105 (5) ◽

pp. 466-473 ◽

Cited By ~ 1

Author(s):

Karen Luyt ◽

Sally L Jary ◽

Charlotte L Lea ◽

Grace J. Young ◽

David E Odd ◽

...

Keyword(s):

Treatment Group ◽

Randomised Controlled Trial ◽

Standard Treatment ◽

Controlled Trial ◽

Fibrinolytic Therapy ◽

Ventricular Dilatation ◽

Cognitive Disability ◽

Randomised Controlled ◽

Standard Treatment Group

BackgroundProgressive ventricular dilatation after intraventricular haemorrhage (IVH) in preterm infants has a very high risk of severe disability and death. Drainage, irrigation and fibrinolytic therapy (DRIFT), in a randomised controlled trial (RCT), reduced severe cognitive impairment at 2 years.ObjectiveTo assess if the cognitive advantage of DRIFT seen at 2 years persisted until school age.ParticipantsThe RCT conducted in four centres recruited 77 preterm infants with IVH and progressive ventricular enlargement over specified measurements. Follow-up was at 10 years of age.InterventionIntraventricular injection of a fibrinolytic followed by continuous lavage, until the drainage was clear, and standard care consisting of control of expansion by lumbar punctures and if expansion persisted via a ventricular access device.Primary outcomeCognitive quotient (CQ), derived from the British Ability Scales and Bayley III Scales, and survival without severe cognitive disability.ResultsOf the 77 children randomised, 12 died, 2 could not be traced, 10 did not respond and 1 declined at 10-year follow-up. 28 in the DRIFT group and 24 in the standard treatment group were assessed by examiners blinded to the intervention. The mean CQ score was 69.3 (SD=30.1) in the DRIFT group and 53.7 (SD=35.7) in the standard treatment group (unadjusted p=0.1; adjusted p=0.01, after adjustment for the prespecified variables sex, birth weight and IVH grade). Survival without severe cognitive disability was 66% in the DRIFT group and 35% in the standard treatment group (unadjusted p=0.019; adjusted p=0.003).ConclusionDRIFT is the first intervention for posthaemorrhagic ventricular dilatation to objectively demonstrate sustained cognitive improvement.Trial registration numberISRCTN80286058.

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Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial

Gut ◽

10.1136/gutjnl-2018-316074 ◽

2018 ◽

Vol 68 (5) ◽

pp. 796-803 ◽

Cited By ~ 12

Author(s):

James Y W Lau ◽

Rapat Pittayanon ◽

Ka-Tak Wong ◽

Nutcha Pinjaroen ◽

Philip Wai Yan Chiu ◽

...

Keyword(s):

Treatment Group ◽

High Risk ◽

Primary Endpoint ◽

Standard Treatment ◽

Controlled Trial ◽

Recurrent Bleeding ◽

Peptic Ulcers ◽

Endoscopic Haemostasis ◽

Endoscopic Control ◽

Standard Treatment Group

ObjectivesIn the management of patients with bleeding peptic ulcers, recurrent bleeding is associated with high mortality. We investigated if added angiographic embolisation after endoscopic haemostasis to high-risk ulcers could reduce recurrent bleeding.DesignAfter endoscopic haemostasis to their bleeding gastroduodenal ulcers, we randomised patients with at least one of these criteria (ulcers≥20 mm in size, spurting bleeding, hypotensive shock or haemoglobin<9 g/dL) to receive added angiographic embolisation or standard treatment. Our primary endpoint was recurrent bleeding within 30 days.ResultsBetween January 2010 and July 2014, 241 patients were randomised (added angiographic embolisation n=118, standard treatment n=123); 22 of 118 patients (18.6%) randomised to angiography did not receive embolisation. In an intention-to-treat analysis, 12 (10.2%) in the embolisation and 14 (11.4%) in the standard treatment group reached the primary endpoint (HR 1.14, 95% CI 0.53 to 2.46; p=0.745). The rate of reinterventions (13 vs 17; p=0.510) and deaths (3 vs 5, p=0.519) were similar. In a per-protocol analysis, 6 of 96 (6.2%) rebled after embolisation compared with 14 of 123 (11.4%) in the standard treatment group (HR 1.89, 95% CI 0.73 to 4.92; p=0.192). None of 96 patients died after embolisation compared with 5 (4.1%) deaths in the standard treatment group (p=0.108). In a posthoc analysis, embolisation reduced recurrent bleeding only in patients with ulcers≥15 mm in size (2 (4.5%) vs 12 (23.1%); p=0.027).ConclusionsAfter endoscopic haemostasis, added embolisation does not reduce recurrent bleeding.Trial registration numberNCT01142180.

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Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study

10.21203/rs.3.rs-903345/v1 ◽

2021 ◽

Author(s):

Mohammadreza Salehi ◽

Mahdi Barkhori Mehni ◽

Mohammadmehdi Akbarian ◽

Samrand Fattah Ghazi ◽

Nasim Khajavi Rad ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Treatment Group ◽

Mortality Rate ◽

Length Of Stay ◽

Standard Treatment ◽

Ivig Treatment ◽

Icu Length Of Stay ◽

Duration Of Hospitalization ◽

Standard Treatment Group

Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients.Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01).Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

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Evaluation of oral S-1 as a first-line chemotherapy for metastatic HER2-negative breast cancer: An analysis of two randomized phase III studies (SELECT BC-CONFIRM and SELECT BC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1083 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1083-1083

Author(s):

Reiki Nishimura ◽

Hirofumi Mukai ◽

Yukari Uemura ◽

Hiromitsu Akabane ◽

Youngjin Park ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Treatment Group ◽

Adverse Events ◽

Standard Treatment ◽

Metastatic Breast ◽

Phase Iii ◽

First Line ◽

Standard Treatment Group ◽

Line Chemotherapy

1083 Background: Anthracycline regimens and taxane have been first line chemotherapeutic options for HER2 negative metastatic breast cancer. In a previous phase III trial (SELECT BC), non-inferiority of S-1 was demonstrated in terms of overall survival (OS). The SELECT BC-CONFIRM study was designed to confirm the results of the SELECT BC study and to combine the two randomized studies. Methods: Patients (n = 618) in the first trial were randomly assigned (1:1) to the S-1 group or the taxane group. Patients (n = 230) in the second trial (SELECT BC-CONFIRM) were randomly assigned to the anthracycline group or the S-1 group. Treatment continued until tumor progression, unacceptable toxic effects, or completion of six courses in the standard regimen group and four courses in the S-1 group. The primary endpoint was OS and secondary endpoints were progression-free survival (PFS), time to treatment failure, adverse events, HRQOL and cost-effectiveness. A pooled analysis of the two studies was predefined to confirm the results of the SELECT BC study. Results: 1. The HR for the anthracycline group was 1.09 [95%CI 0.80-1.48] in SELECT BC-CONFIRM, and the estimated predictive posterior probability that the HR does not exceed the threshold 1.333 was 90.27%. 2. Median OS was 32.7 months (S-1 group) and 36.3 months (standard treatment group). S-1 was not inferior to standard treatment in terms of OS (p non-inferiority = 0.0062). Median PFS was 11.2 months (S-1 group) and 11.2 months (standard treatment group). 3. Treatment was discontinued due to adverse events (i.e., neutropenia, febrile neutropenia, fatigue and edema) in 5.7% in the S-1 group and 6.6% in the standard treatment group 4. The EORTC QLQ-C30 questionnaire (global health status) revealed that there was no difference between the S-1 and anthracycline groups (p = 0.257), but there was a significant difference between the S-1 and taxane groups (p = 0.0039). Conclusions: S-1 is not inferior to taxane or anthracycline with respect to OS as a first-line treatment for MBC. S-1 should be considered a new option as a first-line chemotherapy for HER2-negative metastatic breast cancer patients. Clinical trial information: UMIN000005449.

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Abstract 113: Beneficial or Harmful? The Role of Intensive Anti-hypertensive Treatment in the Development of Chronic Kidney Disease

Hypertension ◽

10.1161/hyp.70.suppl_1.113 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Ling Wang ◽

Donna Wang

Keyword(s):

Blood Pressure ◽

Treatment Group ◽

Systolic Blood Pressure ◽

Standard Treatment ◽

Intensive Treatment ◽

Percent Reduction ◽

Data Set ◽

Treatment Target ◽

Renal Outcomes ◽

Standard Treatment Group

Hypertension is the leading cause of end-stage renal disease, and one of the goals of anti-hypertensive treatment is to protect the kidney. However, it is unknown how low of blood pressure as the treatment target should be so that anti-hypertensive therapy would not bring harm to patients especially for those already suffer from chronic kidney disease (CKD). Thus, we used the data set from The Systolic Blood Pressure Intervention Trial (SPRINT) to study the effect of lowering systolic blood pressure on renal disease development. The SPRINT data randomly assigned patients with a systolic blood pressure (SBP) of 130 mm Hg or higher to a SBP treatment target of less than 120 mm Hg (intensive treatment, n=4678) or a treatment target of less than 140 mm Hg (standard treatment, n=4683). We examined the effect of intensive treatment on six renal outcomes: 1) CKD composite, 2)50 percent reduction in eGFR, 3) dialysis 4) albuminuria, 5) 30 percent reduction in eGFR for patients with CKD at baseline (n=2646) and 6) albuminuria for patients without CKD at baseline (n=6715). Generalized Estimating Equation is used to account the correlation of blood pressure levels over time. At the end of year 1, the mean SBP was 121.4± 0.21 mm Hg in the intensive treatment group and 136.2± 0.21 mm Hg in the standard treatment group. The patients in intensive group were found to have a higher chance of 30% reduction of eGFR (OR=3.684, 95% CI= 2.51-5.40) than in standard treatment group. There was no difference between intensive and standard treatment groups for other 5 outcomes. In addition, 1 mm Hg elevation in SBP in patients with CDK at baseline significantly increased the chance of CKD composite (OR=1.03, 95% CI=1.01-1.04), the chance of 50 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.05), and chance of 30 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.02). Thus, SBP significantly correlated with renal outcomes in CKD patients. Our data show that five renal outcomes examined using SPRINT data set are not improved by intensive management of SBP in CKD patients, rather, patients received intensive management have a higher risk of eGFR reduction by 30%, which could be detrimental. Our study indicated that intensive SBP management should not be recommended to CKD patients.

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Continuous warfarin administration versus heparin bridging therapy in post colorectal polypectomy haemorrhage: a study protocol for a multicentre randomised controlled trial (WHICH study)

Trials ◽

10.1186/s13063-020-04975-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yasuaki Nagami ◽

Taishi Sakai ◽

Masafumi Yamamura ◽

Masami Nakatani ◽

Takayuki Katsuno ◽

...

Keyword(s):

Treatment Group ◽

Randomised Controlled Trial ◽

Anticoagulant Therapy ◽

Standard Treatment ◽

Controlled Trial ◽

Postoperative Bleeding ◽

Endoscopic Polypectomy ◽

Bleeding Rate ◽

Randomised Controlled ◽

Bridge Therapy

Abstract Background Endoscopic removal of colorectal adenoma is considered an effective treatment for reducing the mortality rates associated with colorectal cancer. Warfarin, a type of anticoagulant, is widely used for the treatment and prevention of thromboembolism; however, bleeding may increase with its administration after polypectomy. In recent times, a high incidence of bleeding after endoscopic polypectomy has been reported in patients receiving heparin bridge therapy. However, previous studies have not compared the bleeding rate after endoscopic colorectal polypectomy between patients who continued with anticoagulant therapy and those who received heparin bridge therapy. We hypothesised that endoscopic colorectal polypectomy under the novel treatment with continuous warfarin is not inferior to endoscopic colorectal polypectomy under standard treatment with heparin bridge therapy with respect to the rate of postoperative bleeding. This study aims to compare the efficacy of endoscopic colorectal polypectomy with continuous warfarin administration and endoscopic colorectal polypectomy with heparin bridge therapy with respect to the rate of postoperative bleeding. Methods We will conduct a prospective multicentre randomised controlled non-inferiority trial of two parallel groups. We will compare patients scheduled to undergo colorectal polypectomy under anticoagulant therapy with warfarin. There will be 2 groups, namely, a standard treatment group (heparin bridge therapy) and the experimental treatment group (continued anticoagulant therapy). The primary outcome measure is the rate of postoperative bleeding. On the contrary, the secondary outcomes include the rate of cumulative bleeding, rate of overt haemorrhage (that does not qualify for the definition of haemorrhage after endoscopic polypectomy), incidence of haemorrhage requiring haemostasis during endoscopic polypectomy, intraoperative bleeding during endoscopic colorectal polypectomy requiring angiography, abdominal surgery and/or blood transfusion, total rate of bleeding, risk factors for postoperative bleeding, length of hospital stay, incidence of thromboembolism, prothrombin time-international ratio (PT-INR) 28 days after the surgery, and incidence of serious adverse events. Discussion The results of this randomised controlled trial will provide valuable information for the standardisation of management of anticoagulants in patients scheduled to undergo colorectal polypectomy. Trial registration UMIN-CTR UMIN000023720. Registered on 22 August 2016

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Effect of Steroid during Perioperative Period in Patients with Patent Ductus Arteriosus (PDA) Ligation

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v5i1-2.53696 ◽

2017 ◽

Vol 5 (1-2) ◽

pp. 9-14

Author(s):

Kazi Zahidul Hoque ◽

Masumul Gani Chowdhury ◽

Mamun Miah ◽

Akhand Tanzih Sultana

Keyword(s):

Treatment Group ◽

Preterm Infants ◽

Standard Treatment ◽

Ductus Arteriosus ◽

Mean Airway Pressure ◽

Surgical Ligation ◽

Pda Ligation ◽

The Mean ◽

Standard Treatment Group ◽

Stress Dose

Background & Objective: Patent ductus arteriosus (PDA) is a common condition in preterm infants and is associated with profound morbidity and mortality. Pharmacotherapy (indomethacin or ibuprofen) is the first choice to close the PDA, but if pharmacological closure is contraindicated or failed, surgical ligation is usually performed. But following surgical ligation of PDA, preterm infants may develop severe hypotension and respiratory failure. Prophylactic stress hydrocortisone (HC) has emerged as a therapy to prevent complications, although its efficacy in reducing postoperative hypotension and oxygenation difficulties has not been rigorously tested. The purpose of this study was to compare the outcomes in preterm infants who received stress HC before their PDA ligation to those who did not (standard treatment group or control). Materials & Methods: This comparative clinical trial was conducted in Dhaka Shishu Hospital (DSH), Dhaka over a period of 15 months between April 2014 to June 2015. A total of 40 infants with a significant PDA and a history of failed medical treatment were included in the study and were divided into two groups (each group having 20 infants) – one receiving stress HC before PDA ligation (Case) and the other did not (Control). Respiratory support, expressed as highest FiO2, highest mean airway pressure and mode of ventilation, was noted as was cardiovascular support including inotropic medication, its dose throughout the preoperative and the postoperative periods. Post-operative cardiovascular and respiratory supports were the main outcome measures which were measured within 72 hours following PDA ligation. Result: At baseline both the study groups were almost similar with respect to their sex, gestational age, birth weight, and age at surgery and prenatal steroid exposure. However, there was more incidence of preoperative steroid exposure in standard treatment group. Urine output was somewhat higher in the standard treatment group compared to the HC group but it was not statistically significant (1.33 vs. 1.21 ml/kg/min, p = 0.205). The mean arterial pressure was higher in the HC group than that in the standard treatment group (92.5 vs. 86.7 mmHg, p = 0.018), but it was clinically insignificant. The study observed that infants who received stress dose HC rarely needed vasopressor support post ligation and their average and highest doses of dopamine were also significantly lower compared to their standard treatment group. The postoperative high-frequency ventilation was more often needed in the standard treatment group, although none in either group needed this support preoperatively. The mean airway pressure was although similar in both groups the highest FiO2 was much less in the HC group. Conclusion: The study concluded that stress dose HC given to preterm infants before surgical ligation of PDA may improve the postoperative cardiorespiratory outcomes. But as the sample size was too small, this finding requires validation by large-scale study. Ibrahim Card Med J 2015; 5 (1&2): 9-14

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Mortality Comparison of Using Anti Interleukin-6 Therapy and Using Standard Treatment in Severe Covid-19

Folia Medica Indonesiana ◽

10.20473/fmi.v57i2.21929 ◽

2021 ◽

Vol 57 (2) ◽

pp. 158

Author(s):

Jonathan Christianto Sutadji ◽

Agung Dwi Wahyu Widodo ◽

Danti Nur Indiastuti

Keyword(s):

Treatment Group ◽

Interleukin 6 ◽

Lung Inflammation ◽

Standard Treatment ◽

Therapy Group ◽

Inclusion Criteria ◽

Randomized Controlled ◽

Significant Difference ◽

Therapy Effectiveness ◽

Standard Treatment Group

Severe Coronavirus Disease 19 (COVID-19) can cause serious lung inflammation and death. COVID-19 is characterized by a high mortality rate. This severity is associated with the overproduction of proinflammatory cytokines called "cytokine storms". One of the cytokines that play a central role is Interleukin-6 (IL-6). High IL-6 levels are associated with mortality. Expectedly, the IL-6 blockade could reduce cytokine storms and thus reduce deaths in severe COVID-19 patients. This systematic review aimed to summarize the comparison between mortality using anti-IL-6 therapy and mortality using standard treatment in severe COVID-19 patients. We systematically searched the PubMed, ScienceDirect, and ProQuest databases until 13 August 2020. After screening, twelve studies matched the inclusion criteria. The mortality of the anti-IL-6 therapy group was lower than the standard treatment group without anti-IL-6 therapy in COVID-19 patients in 10 of the 12 studies obtained. Four of the ten studies statistically found a significant difference in mortality of the anti-IL-6 therapy group and the standard treatment group. Confirmation of anti-IL-6 therapy effectiveness in reducing mortality in severe COVID-19 patients will require randomized controlled trials.

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Effects of different ablation points of renal denervation on the efficacy of resistant hypertension

PeerJ ◽

10.7717/peerj.9842 ◽

2020 ◽

Vol 8 ◽

pp. e9842

Author(s):

Hua Zhang ◽

Ling-Yan Li ◽

Rong-Xue Xiao ◽

Ting-Chuan Zhang ◽

Zong-Jun Liu ◽

...

Keyword(s):

Blood Pressure ◽

Treatment Group ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Standard Treatment ◽

Intensive Treatment Group ◽

The Mean ◽

Standard Treatment Group

Objective To explore the blood pressure response to different ablation points of renal denervation (RDN) in patients with resistant hypertension Methods A total of 42 cases with resistant hypertension treated by RDN in our center from 2013 to 2015 were retrospectively analyzed. The patients were divided into two groups according to the different ablation points of RDN: the standard treatment group (spiral ablation from near to proximal, with less than 8 points per artery) and the intensive treatment group (from near to far by spiral ablation, with at least 8 points per artery), with 21 patients in each group. The ablation parameters, including points, impedance, actual wattage, and actual temperature, were recorded intraoperatively. Renal angiography was performed again after RDN. Ambulatory blood pressure (ABP) images were taken for all patients at the baseline and 6 months after operation. Results The mean 24-h blood pressure of the standard treatment group was lower than that of the baseline (24-h systolic blood pressure decreased by 7.4 ± 10.6 mmHg and 24-h diastolic blood pressure decreased by 4.6 ± 6.1 mmHg), and the mean 24-h blood pressure decreased significantly from baseline to 6 months in the intensive treatment group (24–h systolic blood pressure decreased by 27.4 ± 11.4 mmHg, P < 0.0001; 24–h diastolic blood pressure decreased by 10.9 ± 9.6 mmHg, P = 0.005). There was a positive correlation between the decrease of systolic/diastolic 24-hour mean and the number of ablation points used in the procedure. The mean value of systolic and diastolic blood pressure was positively correlated with ablation points at 24-hour (R2 = 0.777 and 0.633 respectively, P < 0.01). There were no adverse events in either group after the operation and during the follow-up. Conclusions RDN could significantly reduce BP in patients with resistant hypertension. Our study showed that the antihypertensive effect appeared to be positively correlated with the number of ablation points.

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USE OF AVERSION THERAPY IN DISSOCIATIVE PSEUDO-SEIZURE PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1018 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Rakesh Kumar Paswan ◽

Siddharth Aswal ◽

Brajesh Pushp ◽

Yogesh Motwani ◽

Indra Pal Salvi

Keyword(s):

Treatment Group ◽

Electric Current ◽

Global Assessment ◽

Standard Treatment ◽

Test Group ◽

Global Assessment Of Functioning ◽

Dissociative Experiences Scale ◽

Psychiatric Illnesses ◽

Dissociative Experiences ◽

Standard Treatment Group

Background: psychological methods are less commonly used in treatment of psychiatric illnesses in hospital setup. In some psychiatric illnesses drug use has limiting effect in full cure of illness due to psychosocial dynamics associated with those illnesses. Aim: In dissociative conversion disorder one theory states that primary gain is conversion of mental or emotional feeling into physical symptoms and secondary gain is any other external benefit from physical symptom occurred in primary gain. Like in a disturbed marital conflict wife develops episodic unresponsiveness (pseudo seizures) as primary gain and revived attention and care of husband due to this episodic unresponsiveness (pseudo seizures) as secondary gain. It is hypothesized that dissociative conversion reaction develops and become resistant by getting these two primary and secondary gains. Our study aim at providing unpleasant mild aversive electric current to the subjects along with standard pharmacotherapy to make patient condition to this painful stimulus and end their maladaptive behavior. Material and Methods: Structured Clinical Interview for DSM-5 was used for making diagnosis and Dissociative Experiences Scale and Global Assessment of Functioning (GAF) for evaluating the response of treatment. Mild electric current (30 mili columb) was used in test group along with standard treatment group. Results: In test group improvement in terms of Dissociative Experiences Scale and Global Assessment of Functioning (GAF) and number of episodes of unresponsiveness was better. Conclusion: Use of mild electric current as aversive stimulus as compared to standard treatment group was found more affective mode of treatment Keywords: dissociative, conversion, aversion therapy, pseudo seizures, electric current

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